Alopecia

Alopecia

What it is?

Alopecia areata is a disease that affects the hair follicles. The hair follicles are part of the skin, where the root of hair grow. The hair falls out of the follicles in small, round patches. In most casues people suffering from Alopecia areata suffer one or a few bare patches. Rarely, the disease causes total loss of hair on the head or complete loss of hair on the entire body.

Symptoms

The primary system of alopecia is a bald patch, generally a circle somewhere on the scalp. There may also be redness, scaling, mild burning or an itchy feeling on the bald patches. The bald patch can expand from a patch to a larger area. 

Causes

Alopecia areata is an autoimmune disease, when the immune system attacks itself.  The immune system attacks the hair follicles, which stops the hair from growing from the follicle.

The cause is not conslusive, it is believed genetics are a contributing factor. People who have a history of Alopecia areata are at higher risk of also suffering from the disease, however a trigger commences the attack on the hair follicle such as a virus or an environmental factor.

Treatment

Corticosteroids
About treatment

Corticosteroids are powerful anti-inflammatory drugs similar to a hormone called cortisol produced in the body. Because these drugs suppress the immune system if given orally, they are often used in the treatment of various autoimmune diseases, including alopecia areata. Corticosteroids may be administered in three ways for alopecia areata:

Local injections-Injections of steroids directly into hairless patches on the scalp and sometimes the brow are effective in increasing hair growth in most people. It usually takes about 4 weeks for new hair growth to become visible. Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects encountered with long-term oral use. The main side effects of injections are transient pain, mild swelling, and sometimes changes in pigmentation, as well as small indentations in the skin that go away when injections are stopped. Because injections can be painful, they may not be the preferred treatment for children. After 1 or 2 months, new hair growth usually becomes visible, and the injections usually have to be repeated monthly. The cortisone removes the confused immune cells and allows the hair to grow. Large areas cannot be treated.

Oral corticosteroids-Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in more extensive alopecia areata. But because of the risk of side effects of oral corticosteroids, such as hypertension and cataracts, they are used only occasionally for alopecia areata and for shorter periods of time.

Topical ointments-Ointments or creams containing steroids rubbed directly onto the affected area are less traumatic than injections and, therefore, are sometimes preferred for children. However, corticosteroid ointments and creams alone are less effective than injections; they work best when combined with other topical treatments, such as minoxidil or anthralin.

Results
As you can see from the section above, there are various treatment options. It is difficult to say from the outset whether a particular treatment will benefit a particular person. One of the difficulties is that hair grows back without any treatment in many cases. Therefore, it is difficult to research the effect of treatments, as hair may re-grow naturally.

Generally, the success rate for the various treatments is probably not high. Also, there is no guarantee that any hair re-grown during treatment will persist once the treatment is finished.

Anthralin (DCP)
About treatment

Anthralin, a synthetic tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. Anthralin is applied for 20 to 60 minutes (”short contact therapy”) to avoid skin irritation, which is not needed for the drug to work. When it works, new hair growth is usually evident in 8 to 12 weeks. Anthralin is often used in combination with other treatments, such as corticosteroid injections or minoxidil, for improved results.

Sulfasalazine
About treatment

A sulfa drug, sulfasalazine has been used as a treatment for different autoimmune disorders, including psoriasis and rheumatoid arthritis. It is a combination of an aspirin-like anti inflammatory component and a sulphur antibiotic-like component.  It acts on the immune system and has been used to some effect in patients with severe alopecia areata.

Topical sensitizers
About treatment

Topical sensitizers are medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. If the medication works, new hair growth is usually established in 3 to 12 months. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). Their safety and consistency of formula are currently under review.

Photochemotherapy
About treatment

In photochemotherapy, a treatment used most commonly for psoriasis, a person is given a light-sensitive drug called a psoralen either orally or topically and then exposed to an ultraviolet light source. This combined treatment is called PUVA. In clinical trials, approximately 55 percent of people achieve cosmetically acceptable hair growth using photochemotherapy. However, the relapse rate is high, and patients must go to a treatment centre where the equipment is available at least two to three times per week. Furthermore, the treatment carries the risk of developing skin cancer. Long term use has been associated with higher rates of skin cancer.

Minoxidil (5%)
About treatment

Topical minoxidil solution promotes hair growth in several conditions in which the hair follicle is small and not growing to its full potential. Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The solution, applied twice daily, has been shown to promote hair growth in both adults and children, and may be used on the scalp, brow, and beard areas. With regular and proper use of the solution, new hair growth appears in about 12 weeks.

Trichologists
About treatment

Trichologists claim to treat all forms of hair loss, hair shaft breakage, scalp disorders, and the scalp environment. Pure Academic Trichology is a paramedical area of health care that embraces both naturopathic & western medicine, endocrinology and dermatology.

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